Confirmed Exchange QHPs: 12,024,658 as of 5/26/15
Estimated: 12.51M (9.54M via HCgov) as of 5/26/15

Estimated ACA-Enabled Policy Enrollment: 31.8M
(10.1M Paid/Effectuated Exchange QHPs, 8.0M OFF-Exchange QHPs, 300K SHOP, 13.4M Medicaid/CHIP)

Whenever I post about King v. Burwell, I have a tendency to lump all 34 states together into collective numbers (around 6.5 million losing their tax credits, plus another couple million being priced out of the market due to the resulting premium spikes, plus another 4-5 million having to pay through the nose to keep theirs).

However, I decided to break this out by individual state. First, I used the HHS Dept's. official ASPE report from March 10th. This includes all people who selected a QHP via as of 2/22/15.

Next, I assume my standard 88% payment rate. Ironically, the higher this percentage is, the more people who could actually get royally shafted by a King plaintiff win.

Cleaning out more of Ye Olde In Box...

MNsure survived the legislative sessionwithout major changes. Some Republicans wanted to scrap the state's health insurance exchange altogether and some Democrats wanted to make it a state agency.

By some accounts, MNsure's performance has greatly improved since it's rocky 2013 roll out.

MNsure CEO Scott Leitz is leaving his position to work for a health care think tank. He took over the program after its first executive director resigned under fire.

The state Senate overwhelmingly adopted major health care changes Thursday in a bipartisan vote that reins in some facility fees, looks to development of a health information exchange to guarantee the sharing of patient data and aims to keep private physician practices in business.

Ye Olde In-Box is crammed full again, so here goes...

But a new study casts doubt on that theory and suggests Obamacare’s bet may indeed pay off. The study, published in Health Affairs by John Romley, Dana Goldman and Neeraj Sood, found that hospitals’ productivity has grown more rapidly in recent years than in prior ones. Hospitals are providing better care at a faster rate than growth in the payments they receive from Medicare, according to the study.

A new healthcare reform debate may be on the horizon. Democrats refer to the issue at hand as the nation's "underinsured" population, reported the Associated Press.

Last week, I noted that the number of ACA exchange-based QHP selections has officially passed the 12 million mark nationally. I also mentioned that:

Of course, when you throw in the missing tax season SEP / off-season enrollments, the actual total should be closer to 12.4 million or higher, and should finally reach my personal Open Enrollment Period target of 12.5 million by the end of May.

Well, it's a week later, and I'm feeling confident enough (especially with the support of new data out of California) to state that the actual total number should indeed have passed the 12.5 million mark nationally sometime over Memorial Day weekend (or today at the latest, since most exchanges were closed for the holiday).

One of the Big ACA Stories today is Robert Pear's piece in the New York Times about the origin/history of the infamous "...established by the state" wording in the Affordable Care Act which is at the heart of the impending King v. Burwell Supreme Court decision (now just 1 month away from the expected announcement):

...The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. Some described the words as “inadvertent,” “inartful” or “a drafting error.” But none supported the contention of the plaintiffs, who are from Virginia.

Pear goes on to interview and quote various former/current members of Congress and their staff--both Democrats and Republicans alike--all of whom give the same response:

About a week ago, I posted an off-topic entry called "Attorney Chad" is about to have a really bad weekend.

It appears that after the tragic Amtrak derailment a couple of weeks ago, a Philadelphia-based personal injury attorney named Chad Boonswang (allegedly) decided to send out hand-written "sympathy cards" to the families of not just one, but at least two different victims. The "sympathy cards" actually contain no words of sympathy, but instead are crass ads pushing his litigation services at a discounted rate. What a bargain!!

Some Guy, early December:

In other words, every one of the following states--along with the other 2 dozen not already running their own exchanges--should be running, not walking towards at least getting their ducks in a row in case SCOTUS lowers the boom...and instead, every damned one of them appears to have decided to twiddle their thumbs for the next 6 months or so.

Some Guy, late January:

Anyway, let's suppose that #1 and #2 are squared away. Against all odds, the Republican governors and legislators of these states get their heads out of their asses and actually approve all of the above.

That leaves #3: Time. Even if everything was streamlined and fast-tracked (and lord knows that's unlikely), it would still take substantial amounts of time to do all of this.

A few days ago, over at, I pointed out 4 major questions to ask when reading about supposedly-massive rate hikes coming in 2016. This morning I added one more important factor to consider. These boil down to:

  • 1. Is the "average" weighted by company?
  • 2. Is the "average" weighted by plan/metal level?
  • 3. What's the actual old/new pricing?
  • 4. Have the rates been approved yet?
  • 5. Does the rate change reflect how many people switched policies and/or companies?

Number 4 is easy: NO. None of the requested rate changes that you're seeing flying around right now (and will continue to for the next few weeks) have been approved yet. This could dramatically change some of the final rates.

Greg Sargent of the Washington Post notes:

As I’ve noted before, Republicans may try to pass a temporary patch for the subsidies, packaged with something like the repeal of the individual mandate, in hopes of drawing a presidential veto — so Republicans can then try to blame Obama for failing to fix the problem.